Tumors Of The Lung Flashcards

1
Q

Lung tumors general statistics

A

95% of the tumors are adeno or non adeno carcinomas (epithelial linage)

5% are carcinoid, mesenchymal, lymphomas or benign lesions

Peak incidence of lung cancer is 50-60 yrs

At diagnosis, 50% of Patients already have metastasis to distal regions past lymph nodes
- 25% of the total lung cancers have metastasis only to the regional lymph nodes

Prognosis is poor in all lung cancers

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2
Q

Most common benign lung tumor is what?

A

Haramtoma “coin lesion”

- constricts of mature cartilage, fat, fibrous tissue and blood vessels

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3
Q

What is the most important cause of cancer-related deaths?

A

Carcinoma of the lung

  • both male and female
  • is decreasing in men and increasing in women
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4
Q

4 major histologic types of carcinoma in the lungs

A

Adenocarinoma

  • strong association with smoking
  • most common lung tumor in women and people under 45 yrs old

Squamous cell carcinoma
- strong association with smoking

Large cell carcinoma

Small cell carcinoma

  • strong association with smoking
  • almost always metastasis by diagnosis time
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5
Q

Etiology and pathogens is of lung carcinomas

A

All arise by a stepwise accumulation of driver mutations

The order of driver mutations can be varied however the following two things are most common (is NOT random though):

  • TP53 tumor suppressor gene and KRAS oncogene are mutated pretty late
  • 3p tumor suppressor genes are mutated pretty early
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6
Q

EGFR adenocarcinomas

A

A subset of adenocarcinomas that is common in nonsmoking women of Asian descent

Presents with epidermal growth factor receptor mutation that stimulates growth pathways nonstop

If it can be diagnosed early, is highly susceptible to specific oncodrugs that inhibit EGFR signaling
- if diagnosed late cant use

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7
Q

Smoking and cancer

A

Smoking is the cardinal carcinogen associated with lung cancer

  • 90% of lung cancers occur in active smokers or people who recently stopped
  • near linear correlation between frequency of lung cancer and pain-year cigarette smoking
  • 60x more likely in habitual heavy smokers (2 lacks a day for 20years or more)
  • stopping smoking helps, but never returns to baseline levels
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8
Q

What is the most common synergistic interaction between carcinogens?

A

Asbestos and tobacco smoking

  • combined is 55x fold increased
  • sole asbestos is 5x increased
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9
Q

Genetics and carcinomas of the lung

A

Mutagenic effect of carcinomas is modified to be greater by hereditary factors
- specifically, polymorphisms in cytochrome P-450 genes have shown to allow increased ability to activate pro carcinogens in cigarette smoke (leads to increased cancer risk)

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10
Q

Morphology of lung carcinoma

A

All are Typically are firm and gray-white masses

Adenocarcinomas

  • located peripherally usually and grow slowly w/ smaller masses
  • metastasis very early
  • usually grows well-defined acinar patterns or papillary mucinous patters

Squamous cell carcinomas

  • located centrally and spread to hilar nodes
  • metastasis later
  • can show central necrosis patterns and cavitations
  • can look well differentiated or poorly differentiated

Small cell lung carcinomas

  • located centrally and look grayer than the others
  • metastasis to hilar lymph nodes super early, but distally varies
  • salt/pepper patterns with crush artifacts present in histology. Also shows necrosis
  • always express neuroendocrine markers and can secrete polypeptide hormones

Large cell carcinomas
- very undifferentiated w/ large nuclei and can be central or peripheral

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11
Q

Most common lymph node infected by metals is from lung cancers

A

Left supraclavicular node (virchow node)

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12
Q

Vena caval syndrome

A

Carcinomas may compress or infiltrate the superior vena cava which leads to venous congestion

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13
Q

Specifics to apical tumors (pancoast tumors)

A

Often invade the brachial or cervical plexus which is associated with any of the following:

  • severe pain distribution especially along the ulnar nerve
  • Horner syndrome
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14
Q

Clinical features associated with lung carcinomas

A

Symptoms/signs:

  • chronic coughing
  • expectoration
  • chest pain
  • SVC syndrome
  • pericardial/pleural effusion
  • segmental atelectasis
  • pneumonitis
  • metastasis spread symptoms (hepatomegaly, neurologic issues, bone pain)

Are insidious lesions that spread quickly so often are not respectable before symptoms appear

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15
Q

Prognosis in all types of carcinomas

A

Squamous cell and adenocarinoma > LCLC > SCLC

Squamous and adenocarcinomas are almost always curable as long as metastasis isnt present
- use of tyrosine kinase and EGFR Inhibtors can help metastasis, but poor prognosis at this point

SCLCs almost always aren’t possible to surgically resection since roughly 99% have metastasis before diagnosis

  • very sensitive to chemotherapy, but often come back .
  • mean survival is 1 year w/ 5% alive at 10yrs of diagnosis
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16
Q

Paraneoplastic syndromes

A

3-10% of lung cancer patients develop one of these

1) Hypercalcemia
- common in squamous cell

2) Cushing syndrome
- common in SCLC

3) anti-diuretic Hypertrophy
4) myasthenia gravis
5) peripheral neuropathy
6) polymyositis
7) hypertrophic pulmonary osteoarthritis
8) coagulation abnormalities (especially DIC)

17
Q

Carcinoid tumors

A

Malignant tumors composed of neuro secretory granules from the bronchial tissues

  • are considered low-grade neuroendocrine carcinomas
  • 5-15% have metastasized to the hilar nodes by diagnosis, but distant metastasis is rare

Usually result in one of the following two patterns

  • obstructing polyploid intraluminal mass
  • a mucosal plaque penetrating the bronchial wall

Can occur as part of the multiple endocrine neoplasia (MEN) syndrome

Represents 5% of all pulmonary neoplasms

18
Q

Difference between typical and atypical carcinoid tumor morphology

A

Typical:

  • nests of uniform cells w/ regular round nuclei cells
  • salt-pepper chromatin appearance
  • absent mitosis
  • little pleomorphism

Atypical:
- same as typical expect displays higher Mitotic rates and smaller areas of necrosis

19
Q

Clinical features of carcinoid tumors

A

Signs/symptoms

  • coughing
  • hemoptysis
  • coughing
  • hemoptysis
  • recurrent bronchial and pulmonary infections
  • carcinoid syndrome (intermittent diarrhea/flushing/cyanosis)

Survival rates are:

  • typical = 85%
  • atypical 35-56%
20
Q

Malignant mesothelioma (MM)

A

VERY correlated to asbestos exposure
- 80-90% of people have had exposure to asbestos

Rare cancer of mesothelioma cells usually arising from parietal or visceral lung pleura

super long latent period of 25-40 years

Smoking does not increase the risk of developing MM

21
Q

3 morphological appearances of malignant mesothelioma

A

1) epithelial
- cuboidal cells with small papillary buds line tubular and microcytic spaces

2) sarcomatous
- spindles cells grow in sheets

3) biphasic
- possess both sarcomatous and epithelial areas